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Juvenile laryngeal papillomatosis.
Prim Care Respir J. 2006;15(2):125-7.
Always ask
about hoarseness and quality of voice in a history of any child
presenting with cough or asthma-like symptoms. Children presenting
with what appears to be an acute onset of hoarseness, without any
physical signs of airways obstruction, should be reviewed after two
weeks. If there is chronic hoarseness, referral to an ENT specialist
should be considered with a view to laryngoscopy. If the child
develops clinical signs of acute airway obstruction such as stridor
or respiratory distress, prompt paediatric review is indicated. When
referring, it is important to emphasise whether or not there is
chronic hoarseness in order to differentiate the diagnosis from
croup. Juvenile Laryngeal Papillomatosis may present with cough,
pneumonia, dysphagia, or stridor, as well as hoarseness. These
patients are often misdiagnosed as having asthma or allergies.
Recurrent
respiratory papillomatosis in children: masquerader of common
respiratory diseases.Pediatrics.
2006 Nov;118(5):1925-31.
BACKGROUND:
Recurrent respiratory papillomatosis in children is an uncommon but
potentially life-threatening benign tumor of the respiratory tract
with laryngeal predilection. The diagnosis of recurrent respiratory
papillomatosis may be challenging unless there is a high index of
suspicion and awareness of the variable presentations. METHODS: We
reviewed the medical charts of children with recurrent respiratory
papillomatosis treated at a tertiary children's hospital. The
presentation of recurrent respiratory papillomatosis is illustrated
by a series of case reports. We provide a paradigm to assist in the
early diagnosis of children with recurrent respiratory
papillomatosis. RESULTS: Five patients, aged 2 to 6 years, were
erroneously diagnosed with recurrent croup, asthma, laryngeal
hemangioma, and tracheomalacia after presenting with variable
degrees of chronic dyspnea, cough, stridor, dysphonia, weak cry, and
syncope. Once the diagnosis of recurrent respiratory papillomatosis
was made, recurring surgical ablation of papillomata was initiated.
CONCLUSIONS: Any child presenting with a voice disturbance with or
without stridor is recommended to have diagnostic flexible
fiber-optic laryngoscopy. Recurrent respiratory papillomatosis
should be considered in children when other common pediatric airway
diseases either do not follow the natural history or do not respond
to treatment of the common disorder.
Lower airway
papillomatosis in children.Int
J Pediatr Otorhinolaryngol. 2003
Oct;67(10):1117-21.
Laryngeal
papilloma in children is a frequent disease caused by human
papilloma virus (HPV) type 6 or type 11. This disease has a tendency
to recur and the changes are histologically benign. In some cases
papilloma may affect the lower levels of the respiratory tract. In
this study, among 90 patients treated for laryngeal papillomatosis,
in four children papilloma of trachea, bronchi and lung tissue were
detected in endoscopic and radiological examination. This
constitutes 4.4% of all patients. Compact nodules and acquired cysts
between 5 and 50 mm long were found in chest X-rays and in
computerised tomography. These cysts appeared from 4 to 8 years
after establishing a diagnosis of laryngeal papilloma, and 1 year
after recognising papilloma in the trachea. In all four children the
presence of nodules and cysts in the lungs was preceded by recurrent
pneumonia, emphysema or atelectasis of the lungs. All children with
laryngeal papillomatosis should have a chest X-ray. Detection of
acquired cyst-like changes in lung tissue in children with laryngeal
papillomatosis is a warning of future papilloma in the trachea and
bronchi, with involvement of lung tissue. In differential diagnosis
of these changes in the lungs we should take into consideration the
presence of papilloma in the bronchi. A prognosis of papillomatosis
in the lower airways in children is always serious.
Laryngeal
papillomatosis with airway obstruction in an infant.Acta
Anaesthesiol Scand. 2001
May;45(5):645-8.
Laryngeal
papillomatosis in infants and children is a benign condition, but
the location and a marked tendency for recurrence makes the disease
both dangerous and troublesome. This case report deals with a little
girl who had suffered hoarseness and wheezing since she was born.
The diagnosis of laryngeal papillomatosis was made when she was 17
months old. By that time, the tumour had reached a size that
necessitated a tracheotomy to secure the airway. The symptoms and
differential diagnoses are discussed, and it is stressed that
chronic hoarseness and wheezing sounds in infants and children
should make a doctor suspect laryngeal papillomatosis. Laser
treatment and anaesthetic management of small children with a
compromised airway are discussed. As tracheal intubations and
tracheotomy increase the risk of the disease spreading to the
trachea and bronchi, an example is given of treating laryngeal
papillomatosis with potassium titanyl phosphate (KTP) laser, using a
laryngeal mask as an airway to avoid tracheal intubation. Whether
this procedure can reduce the need to perform a tracheotomy in some
of these small patients remains to be seen.
Laryngeal
papillomatosis presenting as acute airway obstruction in a child.
Pediatr Emerg Care. 1999
Dec;15(6):419-21.
Upper
airway obstruction, regardless of cause, can masquerade or be
misdiagnosed as lower airway disease in children. In such cases,
therapeutic trials of antibiotics, bronchodilators, and
over-the-counter medications for symptom relief routinely fail;
however, the original diagnosis often goes unchallenged. If the
obstructive process is progressive, then acute occlusion of the
airway may occur, rapidly leading to suffocation and death if
resuscitation is unsuccessful. Outlined in this report is the case
of a young female with a history of asthma, poorly responsive to
outpatient treatment, who presented with respiratory arrest. The
cause of the respiratory collapse was later identified as a large
laryngeal papilloma, a condition rarely encountered by emergency
physicians.
The
relationship of histologic and clinical factors in laryngeal
papillomatosis.
Arch Pathol Lab Med. 1985
Jan;109(1):24-9.
Laryngeal
papillomatosis is a disease that can lead to many surgical
procedures, especially in children, and is potentially lethal. In
this study, we reviewed 83 cases that yielded 902 separate
laryngoscopy specimens to determine if any clinical or histologic
findings were prognostic. "Juvenile" (n = 73) and "adult" (n = 10)
cases were classified according to the number of separate lesions
and the number of recurrences, but not necessarily according to age.
Four prognostic indicators were constructed for the juvenile group
and were analyzed by linear regression. Three new microscopic
classifications were used: papillary, acanthomatous, and
angiokeratotic. In juvenile cases, the last two categories appeared
to be somewhat prognostic, along with several other factors. Some
histopathologic findings contradicted classic descriptions.
Differences in clinical manifestation and similarities in
histopathology may suggest differential responses to the same causal
agent.
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